The Medicare Prescription Drug Improvement and Modernization Act of 2003, signed into law December 8, 2003 by President George W. Bush, provides coverage of an initial preventive physical examination to new beneficiaries. The examination must include a number of screenings, including screening for hearing loss and balance disorders (falls risk).
The new benefit, known as the Welcome to Medicare examination, has certain limitations:
- The beneficiary must have enrolled in Medicare (Part B) on or after January 1, 2005;
- The preventive examination must be done within 6 months of the beneficiarys first coverage period;
- The examination is a once-in-lifetime benefit.
The examination may be provided by a physician or qualified non-physician practitioner (such as a nurse practitioner or physician assistant).
According to the Centers for Medicare and Medicaid, the examination does not require actual audiometric testing for hearing loss or testing for dizziness. Rather, it is a review of the patients functional ability using screening questions or a screening questionnaire recognized by a national medical organization.
If the screening questionnaires suggest possible hearing loss or dizziness, the patient should receive education, counseling, and referral as deemed appropriate by the physician or non-physician practitioner.
A complete description is available at www.cms.hhs.gov.
Screening and Management of Adult Hearing Loss
The new Welcome to Medicare examination includes screening for hearing loss as part of the initial preventive physical examination.
Hearing loss is one of the most common problems in this population, with a prevalence of 25 to 40% in adults over 65 years of age. Many health organizations, including the US Preventive Service Task Force and the American Academy of Family Physicians, have recommended that hearing screening be part of the regular physical examination for this group.
Unfortunately, hearing loss often goes undetected. The loss usually develops very slowly and only certain sounds are affected, so the individual may not notice the change. There is also a tendency to minimize the effects of hearing loss because of the stigma associated with hearing loss and hearing aids.
But untreated hearing loss has significant negative effects on both the individual and family. A study of 3,000 adults conducted by the National Council on the Aging found that adults with untreated hearing loss are 1.5 times as likely to report depression, 1.5 times as likely to feel anxious, and are less likely to participate in social activities.
Several studies have found increased incidence of health dysfunction in patients with hearing loss. Other studies have found that untreated hearing loss may lead to increased family stress, tension and irritation. Spouses may reduce both their frequency and content of interaction. For example, the couple may limit themselves to talking only about important matters because of the effort required.
Fortunately, the negative effects of hearing loss can be minimized once the loss is identified. A number of studies have found hearing aids to be very successful treatments for reversing the social, emotional and communication dysfunction caused by hearing impairment. One study reported significant improvement in functional health status in patients with hearing loss after they began using hearing aids:
The improved communication that occurred as a result of using hearing aids may have improved the individuals perception of health impairment rather than his or her actual physical status.
Many of these research findings were presented in a comprehensive review of more than 1500 articles on hearing loss. Yueh et al. concluded:
Hearing loss is one of the most common chronic health conditions and has important implications for patient quality of life. However, hearing loss is substantially underdetected and undertreated.2
The authors also found strong evidence that the treatment of hearing loss improves quality of life.
Yueh et al. discussed screening procedures, including the use of questionnaires such as the Hearing Handicap Inventory for the Elderly (HHIE). The Welcome to Medicare exam allows a questionnaire screening rather than actual hearing testing. The authors also recommended audiologic evaluation for patients who fail the screening:
Audiometric testing by audiologists is not only the criterion standard for diagnosing hearing loss, but critical for determining (type of) hearing loss, which strongly influences choice of therapy.
The Physician and Hearing Health Care
While hearing care professionals provide the nonmedical evaluation and rehabilitation treatment to people with hearing loss, the most important source of information and encouragement is the patients primary care physician.
In a survey of more than 3,500 adults with hearing loss, 65% of respondents listed their primary care physician as their most important source of information about their hearing healthcare needs. Physician-referred patients are also much more likely to be successful hearing aid users, according to Sergei Kochkin, PhD, director of the Better Hearing Institute (www.betterhearing.org). Individuals with hearing loss especially need encouragement from their personal care physician because of their tendency to deny the presence of hearing loss or to minimize its effects on themselves and their families.
Unfortunately, research has shown that physicians often give negative recommendations concerning hearing aids. Typical comments include, You seem to be hearing me fine, Some hearing loss is normal as you get older, and Do you really want to bother with hearing aids?
These statements are sometimes made in spite of dramatic changes in the way hearing health care is provided, significant improvements in hearing aid technology, and research confirming both the negative effects of hearing loss and the beneficial effects of the most common treatment for chronic hearing loss (hearing aids).
|Dennis Hampton, PhD, is an audiologist and editor of Hearing HealthCare News®, a customized patient newsletter, and Audiology HealthCare News®, a customized physician newsletter. This article was adapted from the Spring 2005 edition of Audiology HealthCare News® a newsletter that dispensing professionals send to their local physicians.|
1. Yeuh B, Shapiro N, MacLean CH, Shekelle PG. Screening and management of adult hearing loss in primary care: Scientific review. JAMA. 2003;15(289):1976-1985.
2. Kochkin S. MarkeTrak VI: The VA and direct mail sales spark growth in hearing aid market. Hearing Review. 2001;8(12):16-24,63-65.
Correspondence to Dennis Hampton, 280 Mamaroneck Ave, Ste 204, White Plains, NY 10605; email: [email protected].